Omitting Cortical Renorrhaphy in Robot-Assisted Partial Nephrectomy: Is it Safe? A Single Center Large Case Series

Area of Science:

• Urology
• Surgical Oncology
• Nephrology

Background:

• Preserving renal function after robot-assisted partial nephrectomy (RAPN) is crucial.
• The necessity of double-layer cortical renorrhaphy for preventing urinary leaks and bleeding is debated, as it may lead to parenchyma loss and worse outcomes.

Purpose of the Study:

• To evaluate the safety and feasibility of omitting the second layer of cortical renorrhaphy during RAPN.

Main Methods:

• Retrospective analysis of 146 patients undergoing RAPN.
• Patients were divided into single (inner layer only) and double renorrhaphy groups.
• Data collected included demographics, tumor characteristics, perioperative parameters (blood loss, duration, warm ischemia time), postoperative complications, estimated glomerular filtration rate (eGFR) changes, length of stay, and oncologic outcomes.

Main Results:

• No significant differences in patient demographics or tumor characteristics between groups.
• The single renorrhaphy group had a reduced surgery duration (125 vs. 143 minutes, p=0.006) and a trend towards shorter warm ischemia time (12.9 vs. 14.0 minutes, p=0.05).
• No significant differences were observed in blood loss, postoperative complications, eGFR change at 3 months, length of stay, or oncologic outcomes (recurrence, death) after a median follow-up of 35 months.

Conclusions:

• Omission of the second layer of cortical renorrhaphy in RAPN is a safe and feasible technique.
• This approach does not increase the risk of urinary leaks or complications.
• It may lead to shorter operative times without compromising renal function or oncologic control.